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General NPI Number Information
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NPI Number | 1265627426
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Entity Type | Organization
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Legal Business Name | QUALCARE MEDI CENTER, PA
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 1600 SAINT GEORGES AVE SUITE 216
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City | RAHWAY
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State | NJ
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Zip | 07065-2764
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Country | US
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Telephone | 732-396-0777
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Fax | 732-936-9222
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Provider Business Mailing Address
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Address Line | 1600 SAINT GEORGES AVE SUITE 216
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City | RAHWAY
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State | NJ
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Zip | 07065-2764
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Country | US
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Telephone | 732-396-0777
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Fax | 732-936-9222
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GEORGE W LONG
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Credential | MD
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Telephone | 732-396-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA06993300
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License Number State | NJ
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